Library: Policy

317:30-5-232. Coverage

Revised 2-21-23

        Lactation Consultant services are covered for pregnant women and women up to twelve (12) months postpartum.  SoonerCare members may self-refer or be referred by any provider.  Reasons  for lactation services include but are not limited to the following:

(1) Prenatal education/training for first-time mothers;

(2) Women who have not previously breastfed, have a history of breastfeeding difficulty, have identified risk factors for breastfeeding difficulty or lactation insufficiency (e.g., history of breast surgery, infertility, hormonal imbalance, diabetes, obesity);

(3) Women expecting an infant with risk factors for ineffective breastfeeding (e.g., preterm, multiples, congenital birth defects);

(4) Latch-on difficulties;

(5) Low milk supply;

(6) Breastfeeding a premature baby (thirty-six (36) weeks or less gestation);

(7) Breastfeeding multiples; and

(8) A baby with special needs (e.g., Down Syndrome, cleft lip/or palate).